Investigation of the toxic dose of ingested delta-8 tetrahydrocannabinol among young children.

BACKGROUND: Ingestion of delta-8 tetrahydrocannabinol (Δ8THC) by young children is recognized as a public health concern and is commonly encountered by healthcare providers; however, a better understanding of Δ8THC toxicity in this age group is needed. The objective of this study is to investigate the relationship between body weight-based doses of ingested Δ8THC and clinical outcomes among children < 6 years old. METHODS: Using data from the National Poison Data System, we analyzed single-substance Δ8THC ingestions reported to United States poison centers to investigate the dose-response relationship between Δ8THC dose and clinical outcomes, including severe and prolonged toxicity, followed by receiver operator characteristic (ROC) curve analyses. RESULTS: There were 232 cases (median age: 3.0 years, 51.7% female) and the median ingested Δ8THC dose was 6.7 mg/kg. CNS depression (75.5%) was the most common related clinical effect. There was a dose-response relationship between dose and CNS depression severity. Children who ingested a dose in the top quartile (> 17.0 mg/kg) had 3.43 times (95% CI: 1.44-8.14) greater odds of experiencing severe toxicity and 5.02 times (95% CI: 2.05-12.29) greater odds of prolonged toxicity than those who ingested a dose in the lowest quartile (< 2.4 mg/kg), with prolonged toxicity demonstrating a similar dose-response relationship. During ROC curve analyses, a dose cutoff of 2.3 mg/kg yielded a sensitivity of 91% with a specificity of 31% for identifying severe toxicity (area under the curve [AUC] = 0.64) and a sensitivity of 91% with a 37% specificity for identifying prolonged toxicity (AUC = 0.62). A dose cutoff of 1.7 mg/kg yielded a sensitivity of 98% with a specificity of 28% for identifying severe toxicity and a sensitivity of 93% with a 30% specificity for identifying prolonged toxicity. CONCLUSIONS: Despite limitations of NPDS data and inconsistent quality control and labeling of Δ8THC products, the findings of our study are similar to those previously described for delta-9 tetrahydrocannabinol ingestions among young children. We found that a 1.7 mg/kg dose cutoff value for Δ8THC had a high sensitivity for identifying severe or prolonged toxicity associated with Δ8THC ingestions among children < 6 years old; however, it was associated with a high number of false positives.